Provider Demographics
NPI:1114955440
Name:SHUFELDT, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:SHUFELDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 W MINERAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5685
Mailing Address - Country:US
Mailing Address - Phone:303-759-0854
Mailing Address - Fax:303-759-0864
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-406-3000
Practice Address - Fax:602-406-7165
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17236207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ069030Medicaid
AZP30020539OtherRAILROAD MEDICARE
AZ930115452OtherRAILROAD MEDICARE
AZ930128433OtherRAILROAD MEDICARE
AZ930045347OtherRAILROAD MEDICARE
AZZ113684Medicare PIN
AZZ69408Medicare PIN
AZZ77148Medicare PIN
AZZ100975Medicare PIN
AZP30020539OtherRAILROAD MEDICARE
AZZ63716Medicare PIN
AZZ73050Medicare PIN
AZZ502388Medicare PIN
AZZ85310Medicare PIN
AZZ108180Medicare PIN
AZ930115452OtherRAILROAD MEDICARE
AZZ76255Medicare PIN
AZ930045347OtherRAILROAD MEDICARE
AZ069030Medicaid
AZ930128433OtherRAILROAD MEDICARE
AZZ107985Medicare PIN